Duodenal Switch (Ann Surg) 2006 DS superior weight loss w/BMI 50+

Ann Surg. 2006 Oct;244(4):611-9. Related Articles, Links

Comment in:

• Nat Clin Pract Gastroenterol Hepatol. 2007 May;4(5):250-1.

Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass.

Prachand VN, Davee RT, Alverdy JC.

University of Chicago, Chicago, IL 60637, USA. [email protected]

OBJECTIVES: Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directly comparing weight-loss outcomes in super-obese patients following biliopancreatic diversion with duodenal switch (DS) and Roux-en-Y Gastric Bypass (RYGB).
 
METHODS: All super-obese patients (BMI > or =50 kg/m) undergoing standardized laparoscopic and open DS and RYGB between August 2002 and October 2005 were identified from a prospective database. Two-sample t tests were used to compare weight loss, decrease in BMI, and percentage of excess body weight loss (% EBWL) after surgery. chi analysis was used to determine the rate of successful weight loss, defined as achieving at least 50% loss of excess body weight.

RESULTS: A total of 350 super-obese patients underwent DS (n = 198) or RYGB (n = 152) with equal 30-day mortality (DS,1 of 198; RYGB, 0 of 152; P = not significant). The % EBWL at follow-up was greater for DS than RY (12 months, 64.1% vs. 55.9%; 18 months, 71. 9% vs. 62.8%; 24 months, 71.6% vs. 60.1%; 36 months, 68.9% vs. 54.9%; P < 0.05). Total weight loss and decrease in BMI were also statistically greater for the DS (data not shown). Importantly, the likelihood of successful weight loss (EBWL >50%) was significantly greater in patients following DS (12 months, 83.9% vs. 70.4%; 18 months, 90.3% vs. 75.9%; 36 months, 84.2% vs. 59.3%; P < 0.05).

CONCLUSIONS: Direct comparison of DS to RYGB demonstrates superior weight loss outcomes for DS.

Publication Types:

• Comparative Study

PMID: 16998370 [PubMed - indexed for MEDLINE]

PMCID: PMC1856567

I did not have BMI of 50+, but I am hoping that I have great results!!

I originally wanted the DS - good luck getting approved with a BMI of less than 50. 

I already had the DS done!

5'6.5 inches tall and 273 pounds with a BMI 43.4

Sorry bout that - but I do have a problem with you posting studies about this just randomly when you haven't been asked by another member why you had this surgery and it's benefits.  Not that I disagree with you or the studies you posted.  However, every one chose the right surgery for themselves and so did you.  Stop posting about why your surgery is better than they others.  It worked for you congratulations and post on the RNY board and see how lovingly they respond.

PS - you've caught me on a bad day I'm usually sweet but I just hate it when people do this.  Instead of doing this we should encourage everyone to do their own research and find the surgery that best suites them and their lifestyle.

Sal

Sal,

So, in all of your posts that you have EVER posted, it was IN RESPONSE to another member?  Or, did you ever initiate any post without another member asking you to.

I posted a scholarly journal article.  The article is comparing RNY and DS.  I'm sorry if because you had the RNY this article offends you, Sal.  However, it does not make the journal article less correct, or less important because you don't like it. 

Don't you think that other Minnesotans MIGHT like to read this as pre-ops and have all their information before they make a decision for weight loss surgery.

You yourself said you would have liked the DS.  Well, what if another pre-op "might" to?  Would you want to EMPOWER other OH Members to make a totally informed and ACCURATE decision?  It makes me wonder your true intent toward other members.  Do you just want everybody else to have the Roux En Y too?  Or, would you support their decision to have the Duodenal Switch?  Because, I think that there are people who do really well, with RNY!  And, so if that works, then more power to people.  The majority of my formerly obese friends have had Roux En Y.  It has worked for many of them. 

Too many surgeons are not skilled enough to perform the Duodenal Switch.  Too many surgeons will promote their money maker, rather than the surgery with the most researched successes. 

I believe in sharing information, providing information to other people.  This is NOT AN EXCLUSIVE ROUX EN Y FORUM FOR MINNESOTANS, Sal, so Lighten up. 

And, so don't assume that every Minnesotan has to have the Roux En Y.  The University of Minnesota Physicians has several surgeons that perform the doudenal switch both lap and open.  So, don't just stuff all Minnesota pre-ops into your category.  They perform the DS on BMI's UNDER 50 as evidenced by my surgery. 

If you truly believe in people picking their own surgeries and making an informed choice, then the post really wouldn't bother you the slightest.  But, the post bothers you because it is saying that a different surgery might just be a little better than the surgery that you chose, for some people.  THAT is what bothers you.  Admit it and don't act like you are supporting all surgies and informed choices. 

It is not my opinion, so you will have to be angry with the surgeons and scholars that wrote the article and did the research.  Your battle is not with me.  It is within yourself.

Kathy

These studies DO get posted on the Rny forum - there I guess I could see someone get their shackles up.  But HERE?  This isn't an RnY only forum.  If all someone wants to read about or hear about, then maybe THEY should be only on the RnY forum.  Comparing how 'lovingly they respond' between a surgery forum and a state forum seems a bit odd to me.  Is MN an RnY only state?

Can I ask how you got approved with a BMI lower than 50?  (not trying to be too personal - just curious)  And who is your insurer?  I have known several who have had a heck of a time getting approval for DS, even with a BMI over 50.  It wasn't an option for me, but I am curious about it.  Thanks!

Hi Renee,

That's not personal at all!  :)  I have HealthParnters insurance.  They automatically cover RNY, Lap Band, and the Duodenal Switch.  I had approval immediately after completing their requirements.  They have no BMI limitations for the Duodenal Switch that I am aware of. 

I talked to Buchwald first thing about wanting the Duodenal Switch.  It was no problem.  He had no problem with my BMI.

I also did not have High Blood Pressure.  I did not have diabetes.  I did not have any comorbids, albeit GERD (which the DS only cures at 50%, and is the one comorbid that RNY cures to a greater extent), and arthritis in my knees, and higherish cholesterol. 

 HealthPartners in MN rocks!!!

Kathy

Renee, we have several DS patients who've had their surgery covered with BMI's under 50. One patient even had a BMI of 42 and was still able to get approval. So, it can be done!